Injury to the central nervous system (CNS) has devastating effects on the structure and function of the brain and spinal cord. Since the early 1980s, immense research progress has been made and has given hope that injuries to the CNS will one day be repairable. Still, there is much that researchers need to learn about the complex processes that occur in the brain and spinal cord after injury, and how those processes can be changed or reversed.

Miami Project investigators carry out a broad scope of research to address the consequences of neurological injuries. Their work is directed at the following areas:

•Understanding what happens after CNS injury

•Protecting the injured brain and spinal cord from further damage

•Replacing dead nervous system cells (neurons and glia)

•Promoting and guiding axon growth

•Reestablishing essential circuitry

•Preventing and treating complications

•Maintaining maximum potential for recovery

•Translating findings from laboratory research to clinical trials

Defining a CureInjury to the central nervous system affects many body systems and functions that influence the health and well-being of a person. Often, when one thinks of a cure, the focus is on restoring motor function, or walking.

However, cures for spinal cord injury—as defined in a report by the Institute of Medicine of the National Academies—should alleviate the multiple disabilities that result from spinal cord injury.

“Spinal cord injury research should focus on preventing the loss of function and on restoring lost functions—including sensory, motor, bowel, bladder, autonomic, and sexual functions—with the elimination of complications, particularly pain, spasticity, pressure sores, and depression, with the ultimate goal of fully restoring the activity and function of an individual to his or her pre-injury levels.”

In 1999, I generated a position statement that was published in the Winter issue of THE PROJECT emphasizing the complexity of developing treatments to target paralysis following spinal cord injury (SCI). Even after only two years as Scientific Director of The Miami Project, it became clear to me that a simple or single discovery was most likely not going to produce the cures that our scientific programs were targeting. Indeed, the concept of a single “silver bullet” leading to successful regenerative and reparative processes that would produce clinically meaningful improvements in function and quality of life for people living with paralysis was not likely correct. Based on an emerging scientific literature, our scientists and clinicians emphasized that most likely, multiple steps or approaches each bringing us closer to the cure would be the means by which our goals could be met. Even in those early years of paralysis research, several investigators were attempting to translate new approaches into the clinical area or conducting clinical studies that would serve as a foundation for future clinical trials.

To capitalize on our chances of making real progress on the complicated problem of SCI paralysis, appropriate steps or therapeutic targets needed to be identified to enhance the translation of our discoveries into people. Because of this overarching research goal and my own attempt to clarify why a program such as the Miami Project was unique and important to the field, the concept of Five Steps to a Cure was advanced. As I begin my 17th year as Scientific Director of this remarkable program, it might be informative and timely to reconsider those proposed steps and determine how much progress we have made over these years using our multidisciplinary team science approach. Today, because of the hard work of our Miami Project scientific community in the areas of discovery science, translational programs, and clinical studies, many success stories can be highlighted with many more to come in the future.

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Concluding Remarks

The Miami Project is an internationally established research program that has remained focused on its discovery, translational, and clinical research programs targeting paralysis following SCI. Since 1999 we have significantly progressed on each of those Five Steps to a Cure. Hundreds of peer reviewed papers and chapters have been written and findings presented at national and international meetings. Our list of discoveries and advancements continue to grow and impact the field. The successful translation of many of our programs into the clinic emphasizes the significant progress that our scientific family has made over these years. We continue to work on novel strategies that target the complex field of SCI research to determine how best to advance our scientific programs. Importantly, our program is positioned and scientifically equipped to make major steps forward in terms of our neuroprotective, cellular transplantation, regenerative, and rehabilitation strategies that will make a real difference in people lives today. We sincerely acknowledge our scientific colleagues and supporters for their everlasting support for our research mission. Over the last two decades, our research programs have undergone significant change and redirection without ever losing sight of our ultimate goal. That is the uniqueness of The Miami Project – having the multi-disciplinary depth to address all of the complex pathology associated with SCI, yet never losing focus of the end goal of helping people living with SCI. In the years to come, we will continue to conduct the best science we can and pursue scientific questions that will help find the cures for people living with paralysis.